Infant's rare aneurysm gives surgeons unusual challenge

Updated 1:53 pm, Thursday, August 20, 2015

Photo: Melissa Phillip, Houston Chronicle

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Denny Tran carries his eight-month-old son, Dovovan Tran, after a visit to Memorial Hermann Monday, Aug. 3, 2015, in Houston. When Donovan Tran was 4 months old, he was diagnosed with a rare brain aneurysm. Rather than operate, doctors used a catheter to choke off the aneurysm. less

Denny Tran carries his eight-month-old son, Dovovan Tran, after a visit to Memorial Hermann Monday, Aug. 3, 2015, in Houston. When Donovan Tran was 4 months old, he was diagnosed with a rare brain aneurysm. ... more

It was a mother's worst nightmare: On March 23, Huyen Pham put her healthy 4-month-old baby, Donovan Tran, down for his nap. He'd been throwing up, but after all, he'd just started on solid food, and she reasoned that maybe that was hard on him.

An hour later, when she checked on him, he was limp as a ragdoll, pale and unresponsive. "I thought he was dying," she says.

She and her husband, Denny Tran, jumped in the car with their 5-year-old daughter and the baby, and sped to North Cypress Hospital. From there the Memorial Mermann LifeFlight helicopter took Donovan to Children's Memorial Hermann Hospital at the Texas Medical Center.

But the "why" was unclear. "It's something you don't see in a 4-month-old," he said.

The hemorrhage was blocking the flow of spinal fluid, so Dr. Manish Shah inserted a catheter into the fluid-filled cavity in his head right at his bedside to relieve the blockage, which stabilized the baby. Shah is a UTHealth pediatric neurosurgeon with MNI and Children's Memorial Hermann Hospital.

"Now we had to gather our wits and find out what was going on," Dannenbaum says. "It was time to do detective work."

They gave Donovan a CT scan and angiogram.

The test revealed a large aneurysm, one that, Dannenbaum says, would have been difficult to operate on conventionally. The cause, Shah says, was an intracranial aneurysm, rarely seen in infants. An aneurysm is a balloonlike pouch of the blood vessel's wall that can, after rupture, cause spasms of the blood vessels, build up excess cerebrospinal fluid in the brain and even re-rupture.

Fortunately, the neurosurgeons had an elegant option.

They robotically snaked a plastic micro-catheter - Dannenbaum describes it as "angel-hair pasta" - through the groin, into the aorta, up through the neck and into the brain. They then inserted a tiny platinum filament through the catheter. The platinum thread, upon leaving the catheter, coiled itself into a knot or "big ball of yarn," Dannenbaum says, sealing off the aneurysm. The platinum knot is known as a Guglielmi detachable coil, after the physician who invented it.

The procedure took a little less than 90 minutes.

"This was a challenging case," Shah says. "The procedure was really designed for adults," as was the equipment. Neither surgeon had ever performed it on anyone so tiny.

Over the next week, they were able to wean Donovan off the drain in his head.

The surgeons had felt a little extra social pressure, too, because two members of the surgical team, like Donovan's family, were Vietnamese. They clearly indicated to the doctors that this one was special.

But the surgeons agree that the close synergy between Children's Memorial Hermann and Memorial Hermann was crucial in helping to deliver the care. "We're connected by a hallway," says Shah, and he and Dannenbaum are part of the same department. "It's easy to get the best of care."

Every family whose child comes to the hospital with bleeding on the brain is evaluated by Child Protective Services because it often is the result of trauma, but Donovan's family was cleared quickly.

Donovan spent three weeks in the pediatric intensive care unit before returning home.

After the procedure, Donovan's mother, who just completed her studies to be a nurse practitioner, was worried about the toll on her son and wasn't sure the same baby would be coming back to her. And, in a sense, he hasn't.

He has, in fact, become a much happier baby. The parents think he may have suffered headaches that he just couldn't tell anyone about. With Donovan at a robust 19 pounds, his doctors say now he's meeting all his developmental marks.

The family has set up a GoFundMe to defray medical expenses at gofundme.com/godonovan.

"He acts like a regular baby," Donovan's father says. "We spoil him more now."